New York City Department of City Planning - City of New York



New York City Department of City Planning

Land Use Review Application |Supplemental Form | |

|Special Permit/Authorization/Certification. . . .ZS/ZA/ZC |

| | |

| |APPLICATION NO. |

| | |

| |APPLICATION NO. |

| | |

| |APPLICATION NO. |

| |(If more than five actions are being requested, enter "see attached" below, and list ALL PROPOSED ACTIONS in the same format as |

| |below on a separate sheet titled "Proposed Zoning Special Permits/ Authorization/ Certifications.") |

| |Special Permit (ZS) |

| | |

| | |

|Action(s) requested | |

|pursuant to ZR | |

|(Check one box for | |

|each proposed action) | |

| |Will all parties in interest to the property agree to a restrictive declaration if required? YES NO |

| | |

|Property |Check Applicable Box(es) (If more than one box is checked in the left column, please explain below). |

|ownership/ | |

|interest | |

| | Applicant: Applicant: |

| | Is owner of subject property Is a City agency |

| | Is lessee of subject property Is a State or Federal agency |

| | has contract to lease/buy subject property |

| | Is other (explain real property interest below) |

|Discussion of findings|Statement in Support of Required Zoning Resolution Findings/Declaration of Compliance |

| |(This is the same discussion/statement as in Attachment #11. If it fits below, it may be put here instead of in a separate attachment. If Attachment |

| |#11 has been completed, you may leave this area blank). |

| |[pic] |

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